Authors (including presenting author) :
Lee YCJ(1), Poon CY(1), Fan CC(1), Li L(1)
Introduction :
Urinary incontinence and pelvic organ prolapse (POP) are common disorders among women. Involuntary leakage of urine can be caused by effort, exertion or urgency. In a sample of 540 women in Hong Kong, the proportions of people who experienced stress, urge and mixed incontinence were 40.8%, 20.1% and 15.2% respectively (Wong et al., 2006). POP is the symptomatic descent of pelvic floor structures from their normal anatomical positions, it affects 50% of parous women (Subak et al., 2001). Both disorders are associated with emotional distress and impaired quality of life. Pelvic Floor Muscle Training (PFMT) is the most recommended first-line conservative treatment (Basnet, 2021; Felicíssimo et al., 2010). The hypothesis is that a PFMT physiotherapy program is time efficient and cost effective in reducing urinary incontinence and POP symptoms.
Methodology :
Female patients with a diagnosis of urinary incontinence or POP were recruited to a PFMT program. Groups of 4-5 patients were invited to participate in a single-session class that included education through video and booklet, training of pelvic floor muscles and core muscles, and advice on voiding habit and lifestyle modification. Each patient was followed up with a consultation session 2-8 weeks after the group class, in which, exercises were revised, and individualized voiding habit and healthy lifestyle were encouraged. Patients with a fair response to exercise therapy were given 4-6 sessions of magnetic stimulation to strengthen pelvic floor muscles as an adjunct intervention. Outcome measures including Numeric Global Rate of Change Scale (NGRCS), Urogenital Distress Inventory Short form (UDI-6), and Incontinence Impact Questionnaire Short Form (IIQ-7) were assessed before and after participation in the program.
Result & Outcome :
From January 2022 to December 2022, 102 female patients with mean age 63.5±12.9 were reviewed and 79 of them (77.5%) completed the program. An average of 2.0±0.9 sessions was attended. 65 (82.2%) of discharged patients were able to complete the program within 2 sessions. NGCRS was 3.2±2.7. The mean UDI-6 and IIQ-7 score were significantly decreased from 6.3±3.4 (pre-treatment) to 5.3±4.8 (post-treatment) (p=0.014, 95% CI 0.2 to 1.8) and 4.3±2.7 to 3.2±3.4 (p=0.01, 95% CI 0.3 to 1.9) respectively.
It was found that an individualized physiotherapy consultation session on top of structured group exercise program could enhance improvement of symptoms and emotional outcomes. Peer support also plays an important role as patients could share their own experiences. PFMT Program was shown to be more time-efficient and cost-effective in reducing urinary incontinence and POP symptoms, compared to traditional individual treatment sessions. Future development of the PFMT program may include creation of online education materials and establishment of tele-rehabilitation services. These additional resources may enhance long-term rehabilitation outcomes of the program.
References
Basnet, R. (2021). Impact of pelvic floor muscle training in pelvic organ prolapse. International Urogynecology Journal, 32(6), 1351-1360.
Felicíssimo, M. F., Carneiro, M. M., Saleme, C. S., Pinto, R. Z., da Fonseca, A. M. R. M., & da Silva-Filho, A. L. (2010). Intensive supervised versus unsupervised pelvic floor muscle training for the treatment of stress urinary incontinence: a randomized comparative trial. International urogynecology journal, 21(7), 835-840.
Wong, T., Lau, B. Y. T., Mak, H. L., Pang, M. W., Cheon, C., & Yip, S. K. (2006). Changing prevalence and knowledge of urinary incontinence among Hong Kong Chinese women. International Urogynecology Journal, 17(6), 593-597.
Subak, L. L., Waetjen, L. E., Van Den Eeden, S., Thom, D. H., Vittinghoff, E., & Brown, J. S. (2001). Cost of pelvic organ prolapse surgery in the United States. Obstetrics & Gynecology, 98(4), 646-651.
